Sex, PrEP, and Stigma: Experiences with HIV Pre-exposure Prophylaxis Among New York City MSM Participating in the HPTN 067/ADAPT Study

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Abstract

The HPTN 067/Alternative Dosing to Augment Pre-Exposure Prophylaxis Pill Taking (ADAPT) study evaluated daily and non-daily dosing schedules for oral pre-exposure prophylaxis (PrEP) to prevent HIV. A qualitative sub-study including focus groups and in-depth interviews was conducted among men who have sex with men participating in New York City to understand their experience with PrEP and study dosing schedules. The 37 sub-study participants were 68% black, 11% white, and 8% Asian; 27% were of Hispanic/Latino ethnicity. Mean age was 34 years. Themes resulting from qualitative analysis include: PrEP is a significant advance for HIV prevention; non-daily dosing of PrEP is congruent with HIV risk; and pervasive stigma connected to HIV and risk behavior is a barrier to PrEP adherence, especially for non-daily dosing schedules. The findings underscore how PrEP intersects with other HIV prevention practices and highlight the need to understand and address multidimensional stigma related to PrEP use.

Resumen

El estudio HPTN 067/Dosificación Alternativa para Aumentar la Toma de Pastillas de la Profilaxis Pre-Exposición (conocido por su sigla en inglés, ADAPT) evaluó tres estrategias, una diaria y dos no diarias, para la dosificación de la profilaxis pre-exposición oral (PrEP) para prevenir el VIH. Se realizó un sub-estudio cualitativo que incluyó grupos focales y entrevistas en profundidad con hombres que tienen sexo con otros hombres participando en el estudio en la Ciudad de Nueva York. El motivo del sub-estudio fue entender como los participantes experimentaron la PrEP y las estrategias de dosificación del estudio. Los 37 participantes del sub-estudio fueron 68% negro, 11% blanco y 8% asiático; 27% fueron de etnia hispana/latina. La edad media fue de 34 años. Los temas que resultaron del análisis cualitativo incluyen: La PrEP es un avance significativo para la prevención del VIH; hay una congruencia entre la dosificación no diaria de PrEP y los patrones del riesgo de VIH; y el penetrante estigma relacionado con el VIH es una barrera a la adherencia a la PrEP, especialmente para las estrategias de dosificación no diarias. Los hallazgos subrayan cómo la PrEP se intersecta con otras prácticas de prevención del VIH y resaltan la necesidad de entender y abordar el estigma multidimensional relacionado con el uso de PrEP.

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Most cited references 33

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Defining success with HIV pre-exposure prophylaxis: a prevention-effective adherence paradigm.

Jessica E. Haberer, David R Bangsberg, Jared Baeten … (2015)

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High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya.

Gaudensia Mutua, Frances Priddy, Eduard Sanders … (2013)

This paper used qualitative methods to explore experiences of men who have sex with men and female sex workers in Nairobi and Mtwapa, Kenya, who used oral pre-exposure prophylaxis (PrEP) for HIV prevention as part of a four-month trial of safety, acceptability and adherence. Fifty-one of 72 volunteers who took part in a randomized, placebo-controlled, blinded trial that compared daily and intermittent dosage of PrEP underwent qualitative assessments after completing the trial. Analyses identified three themes: (i) acceptability of PrEP was high, i.e. side effects were experienced early in the study but diminished over time, however characteristics of pills could improve comfort and use; (ii) social impacts such as stigma, rumors, and relationship difficulties due to being perceived as HIV positive were prevalent; (iii) adherence was challenged by complexities of daily life, in particular post-coital dosing adherence suffered from alcohol use around time of sex, mobile populations, and transactional sex work. These themes resonated across dosing regimens and gender, and while most participants favored the intermittent dosing schedule, those in the intermittent group noted particular challenges in adhering to the post-coital dose. Culturally appropriate and consistent counseling addressing these issues may be critical for PrEP effectiveness.

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HIV pre-exposure prophylaxis in transgender women: A subgroup analysis of the iPrEx trial

Madeline B Deutsch, David Glidden, Jae Sevelius … (2015)

Summary Background Oral emtricitabine-tenofovir disoproxil fumarate (FTC/TDF) pre-exposure prophylaxis (PrEP) is used to prevent the sexual acquisition of HIV. Transgender women (TGW) have unique characteristics that may relate to PrEP use, effectiveness, and safety. Methods The iPrEx trial was a randomized controlled trial (RCT) of oral FTC/TDF PrEP versus placebo among men who have sex with men (MSM) and TGW, followed by an open label extension (OLE). Drug concentrations were measured in blood by liquid chromatography and tandem mass spectroscopy. Findings Of the 2499 participants enrolled in the RCT, 29 (1%) identified as women, 296 (12%) identified as “trans”, 14 (1%) identified as men but reported use of feminizing hormones, such that 339 (14%) reported one or more of these characteristics (TGW). Compared with MSM, TGW more frequently reported transactional sex, receptive anal intercourse without a condom, or more than 5 partners in the past 3 months. Among TGW, there were 11 HIV infections in the active arm and 10 in the placebo arm, representing a hazard ratio of 1.1 (95% CI: 0.5 to 2.7). Among active arm participants, drug was detected in none of the TGW at the seroconversion visit, 18% (6/37) of seronegative TGW (P=0.31), and 52% (58/111) of seronegative MSM (P < 0.0001). PrEP use was not linked to behavioral indicators of HIV risk among TGW, while MSM at highest risk were more adherent. Interpretation There were no HIV infections among TGW having drug concentrations commensurate with use of 4 or more FTC/TDF tablets per week. TGW receiving PrEP had low drug concentrations, especially at times of potential HIV exposure, leading to no PrEP effectiveness among this subgroup. Funding U.S. National Institutes of Health and the Bill and Melinda Gates Foundation; study medication was donated by Gilead Sciences.

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Author and article information

Contributors

Julie Franks:

ORCID: http://orcid.org/0000-0001-6329-2301

646-448-0944 , jf642@cumc.columbia.edu

Journal

Journal ID (nlm-ta): AIDS Behav

Journal ID (iso-abbrev): AIDS Behav

Title: AIDS and Behavior

Publisher: Springer US (New York )

ISSN (Print): 1090-7165

ISSN (Electronic): 1573-3254

Publication date (Electronic): 15 November 2017

Publication date PMC-release: 15 November 2017

Publication date (Print): 2018

Volume: 22

Issue: 4

Pages: 1139-1149

Affiliations

[1 ]ISNI 0000000419368729, GRID grid.21729.3f, ICAP at Columbia University, Harlem Prevention Center, ; 215 W. 125th St., Suite A, New York, NY 10027 USA

[2 ]ISNI 0000000419368729, GRID grid.21729.3f, Department of Epidemiology, , Columbia University Mailman School of Public Health, ; New York, NY USA

[3 ]ISNI 0000000086837370, GRID grid.214458.e, Department of Health Behavior and Health Education, , University of Michigan, ; Ann Arbor, MI USA

[4 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Gladstone Institutes, , University of California, San Francisco, ; San Francisco, CA USA

[5 ]FHI 360, Durham, NC USA

[6 ]ISNI 0000 0004 0455 9725, GRID grid.413677.0, Harlem Hospital Center, ; New York, NY USA

Author information

Julie Franks http://orcid.org/0000-0001-6329-2301

Article

Publisher ID: 1964

DOI: 10.1007/s10461-017-1964-6

PMC ID: 5878834

PubMed ID: 29143163

SO-VID: cfb2a821-c04b-457c-aa66-8dd6c5db0532

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.